A new AAP-endorsed document provides overarching guidance for clinicians, administrators and policymakers on the safe and effective practice of pediatric telehealth.
Published by the American Telemedicine Association (ATA), the guidance is the result of a three-year, unprecedented collaborative effort by multiple clinical, administrative and industry leaders in pediatric telehealth, including representatives from the AAP Section on Telehealth Care.
A link to Operating Procedures for Pediatric Telehealth, available at http://pediatrics.aappublications.org/content/early/2017/07/19/peds.2017-1756, will be published in the August issue of Pediatrics. Access the document at http://bit.ly/2sM31at.
Broad framework
The core issues addressed in the operating procedures include:
- telehealth within the context of the patient-centered medical home (PCMH);
- communication with primary care and referring providers;
- appropriate patient follow-up;
- parent or legal guardian presence during an encounter;
- patient privacy and confidentiality;
- appropriate examination and testing prior to the prescription of treatment;
- legal and regulatory considerations; and
- technical and security considerations.
Importantly, the document does not provide clinical guidance on telehealth applications for specific conditions or diagnoses. The operating procedures were designed to create a framework of broadly applicable recommendations, which serve as a foundation on which to base the development of pediatric telehealth practices, regulations, legislation and specific clinical guidance.
Wide variability
Pediatric telehealth includes a vast array of practices and applications such as 24/7 remote consultation to rural emergency departments by pediatric critical care specialists, school-based telehealth services and remote monitoring in the home for children with chronic conditions.
While these practices are generally viewed as beneficial adjuncts to health care, certain telehealth applications are of particular concern to community pediatricians, due to their potential negative impact on continuity and coordination of care. One such application is the provision of on-demand primary and urgent care services, commonly referred to as direct-to-consumer (DTC) telehealth.
These applications are most often delivered via a patient’s home computer or mobile device, or at walk-up kiosks in retail pharmacies and stores, and focus on addressing minor, acute illnesses. There is wide variability in DTC practice. Many providers of this service offer high-quality care that integrates with the PCMH. In fact, community pediatricians and academic medical centers are increasingly providing DTC telehealth services to their own patients, allowing for enhanced off-hours coverage, increased convenience for patients and an additional revenue stream for the practice.
However, other providers of DTC telehealth services are taking a more entrepreneurial approach, attempting to capitalize on the convenience of telehealth for patients and parents while potentially sacrificing quality. Such services may fall short on issues such as coordination or communication with the PCMH, availability for follow-up and appropriate examination prior to the prescription of antibiotics.
These issues are not unique to telehealth, as other health care delivery models, such as retail-based clinics and stand-alone urgent care centers, have demonstrated similar potential shortfalls. However, the new operating procedures include language to address these issues and encourage the provision of higher quality, more efficient telehealth services for children.
Continued collaboration on pediatric operating procedures, clinical guidelines and research will pave the way for the ongoing development of safe and effective pediatric telehealth practices, and will allow patient- and provider-focused organizations to solidify their leadership role in that development.
Dr. McSwain, a member of the AAP Section on Telehealth Care Executive Committee, chaired the Pediatric Telehealth Work Group, which produced the ATA guidance. He also chairs the ATA’s Pediatric Special Interest Group Section on Best Practices and Guidelines.
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